Provider Demographics
NPI:1336840594
Name:PREMIUM HEALTH INC
Entity Type:Organization
Organization Name:PREMIUM HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GALINA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOOLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-407-7300
Mailing Address - Street 1:365 ROUTE 59
Mailing Address - Street 2:
Mailing Address - City:AIRMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10952-3459
Mailing Address - Country:US
Mailing Address - Phone:718-407-7300
Mailing Address - Fax:
Practice Address - Street 1:1212 SEAGIRT BLVD
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-4551
Practice Address - Country:US
Practice Address - Phone:718-407-7300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PREMIUM HEALTH INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-03-15
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center